The fact that many states have passed elder abuse reporting laws has left care providers with a dilemma. If suspected abuse is reported, the relationship between caregiver and patient may change and the family's difficulties may increase. Indicators of abuse are not easy to differentiate from health problems, especially in the frail elderly. An Elder Assessment Team was established at Beth Israel Hospital to develop a protocol to use in assessing potential abuse. The elder assessment instrument was developed to assess the following areas on a Likert scale: (1) general physical presentation; (2) physical condition; (3) usual life style; (4) social interactions; and (5) medical conditions. Following this protocol, clinicians judge whether they see evidence of abuse and a care team of nurse, physician, and social worker assess and dispose of the case, filing a report with authorities if necessary. Staff awareness of elder abuse has been increased since the implementation of this protocol and staff seem more willing to report their suspicions to an internal group than to file a state agency report. (The Elder Assessment Instrument is appended.) (ABL)